Abdullah Ahmed

Background: Using a glycopyrrolate/formoterol combination to manage COPD patients is considered a new method. The objectives of this study are to evaluate the effectiveness of the glycopyrrolate/formoterol combination against formoterol alone in optimizing lung function in moderate and severe COPD patients.Methods: Twenty patients with chronic obstructive pulmonary disease were of class II and III according to the ASA classification. Patients were prospectively divided into two groups: group 1 was given glycopyrrolate and formoterol metered dose inhalers, and group 2 was given a formoterol nebulizer alone. Optimization of treatment was assessed on the first day, at the second week, and at the fourth week by lung function tests (FEV1 and FVC).Results: Formoterol alone and a combination of formoterol with glycopyrrolate were well tolerated and optimized lung function. FEV1, FVC, and FEV1/FVC ratio significantly increased (p value<0.001). However, the combination of glycopyrrolate and formoterol had a better effect on lung function (FEV1 and FVC) in comparison to formoterol alone (p value<0.001) in 4 weeks of use.Conclusion: Glycopyrrolate/formoterol metered dose inhaler is more effective in the optimization of the condition of patients with COPD disease than a formoterol nebulizer alone.

Introduction Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a qualitative study exploring physician professionalism from the patients’ perspective. Methods Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software. Results Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not. Discussion/conclusions The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients’ perceptions to be an ideal physician should be incorporated into the process of physicians’ training.